Infusion billing is a complex process, and even small errors can lead to denials. One common source of errors is the detailed written order (DWO) because any kind of change—in the formula type for an enteral patient or a dosage change for a chemo patient, for example—requires a new detailed written order. While intake staff, who often receive these changes through fax or phone, typically update the information in their systems, they often fail to create new DWOs prior to dispensing. Incorrect or incomplete DWOs will lead to denials every time. The important thing to remember is that once a claim has been submitted to Medicare, if the DWO is not correct, there is no recourse in getting it corrected for that claim!

So what can your infusion business do to repair this broken link in your intake processes? By following these 5 steps, you can send complete claims and maximize your cash.

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1. Complete a DWO for every new order. Medicare is very specific about the information that needs to be included on the detailed written order. (Click here to see a sample of a complete DWO.) With some software systems, you can create templates to prefill your DWOs with the required information, which will ensure that all your written orders are consistent and compliant.

Every DWO must include:

Patient’s info, physician’s name, date of order, description of separate billable items or kit items, items to be dispensed, dosage concentration, route of administration, frequency of use (“as needed” is not acceptable; this must be specific), duration of infusion, quantity dispensed, and number of refills

Physician signature and date (Medicare accepts electronic signatures, so check into this option to speed up the process and eliminate paper.)

2. Create checklists for intake staff. Intake is the most crucial step in the whole process, and accuracy in this step will reduce headaches later. To ensure that it’s done correctly, create a simple checklist, so when new orders are created, new DWOs are created as well. You might want to wait to confirm delivery slips for Medicare patients until DWOs are provided. Then, check that each DWO has all of the necessary information and that the physician has signed and dated the document correctly. Once claims are submitted, the time frame for payment or denial typically ranges from 14 to 21 days. If your claim status is “pending,” it’s very likely that your claim is under investigation and will be subject to audit review. This is the time to start collecting your follow-up documentation.

3. Check your mail, and respond quickly. CMS often sends paper audits through the mail to the address indicated on their main contact information. Train your mailroom staff to put anything from CMS on a red alert—to be given to the correct billing people immediately. You must respond within 45 days of the audit mail date, so there’s no time to waste. Keep copies of all the documentation you submit, and be sure to include a copy of the audit letter with your response. Make copies of your tracking number and shipping information in the event that CMS fails to receive your response, so you can prove that you responded in a timely manner.

4. Appeal denials when appropriate. Everyone makes mistakes sometimes. If you feel you have a strong case for payment, consider submitting your claim for redetermination, which will require a different CMS official to review it. Providers have 120 days from the date of denial to file for redetermination. If the case is serious enough, the process can then go to reconsideration and then to an administrative law judge. Be sure to have your documentation ready prior to talking with CMS, so you can quickly provide whatever information is required.

5. Reduce errors with a capable software system. Depending on which software system you use, the detailed written order process can be automated and created in a customized template. Some systems also alert users to create new DWOs whenever new orders are created. Train your staff to utilize the alert system (rather than override notifications) so that no claims are processed without DWOs in place. Mediware software solutions automate CMNs and SMNs for this process and reduce errors with pop-up warnings for missing information.